Aortic dissection and other acute aortic syndromes in the emergency department

Authors: Radka Volovárová 1;  Štefan Volovár 2;  Jan Lhotský 2;  Jan Baxa 3;  Martin Matějovič 1
Authors‘ workplace: I. interní klinika LF UK a FN Plzeň 1;  Kardiologická klinika, Centrum vysoce specializované komplexní kardiovaskulární péče LF UK a FN Plzeň 2;  Klinika zobrazovacích metod LF UK a FN Plzeň 3
Published in: Vnitř Lék 2019; 65(7-8): 506-514


Acute aortic syndromes are emergent life-threatening conditions affecting the aorta, which actual incidence is difficult to determine. Mortality of untreated patients increases steadily over time, so early diagnosis and initiation of therapy are crucial. Management of patients in Czech Republic follow, similar as in other European countries, the European Society of Cardiology guidelines from 2014, which were updated in 2018. The basis for diagnosis consists of history, physical examination, ECG, determination of vital signs, hemodynamic status and stratification of dia­gnosis probability by ADD-RS (aortic dissection detection risk score). This is followed by a series of laboratory and imaging examinations, of which the D-dimer, CT aortography and echocardiography are the most important. Recent studies show the benefit of combination of ADD-RS with D-dimer or measurement of ascendant aorta diameter by echocardiography. New emerging biomarkers are currently under investigation. Thanks to advances in technology, magnetic resonance imaging could take place as emergent diagnostic tool in the future. Initial therapy depends on the hemodynamic status of the patient. It must be followed by definitive therapy. In this publication we summarize the approach to a patient with acute aortic syndrome in the emergency department focusing on aortic dissection as its most common type.


ADD-RS – acute aortic syndrome – aorta – D-dimer – dissection

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